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Federal Marshal

I think tramadol has taught us that anything that acts at opioid receptors is going to cause all of the problems of opioids, regardless of the chemical structure. You'd think we might've already learned that lesson with meperidine and fentanyl, but evidently not. That includes kratom, which acts at mu and kappa opioid receptors. If it acts at mu receptors its going to cause dependence.

Sheriff

A number of reasons; public perception, a personal reluctance to take anything (other than Copenhagen ) that might be addictive or slows my physical reaction time and mental acuity, etc.
I realize that it comes across as somewhat hypocritical, considering that I took tramadol for a number of years, but, as I said, I did not know that it was an opioid. I honestly could not feel any effects from it, and it did not relieve any pain I had already incurred. It was somewhat effective, for me, as a pain preventative if I was thoughtful enough to take it ahead of activity that I knew would cause me pain.
I spend a considerable amount of my time behind the wheel and am a very avid hunter and shooting enthusiast, and I would not want to live with the slightest possibility that my judgements, actions, and reactions might be influenced. Additionally, I think, by law you are not supposed to possess firearms if you have a Medical MJ prescription?

Federal Marshal

I stepped up the dosage after it quit doing anything for me, and all that happened to me was an upset stomach. If you and others think Kratom should be banned, because it's too dangerous, then I woudn't doubt that the drug pushers in the streets would gladly say amen to that.

Once again, at least Kratom is much less likely to cause death via overdose.

Has no Rx for his orange obsession.

I stepped up the dosage after it quit doing anything for me, and all that happened to me was an upset stomach. If you and others think Kratom should be banned, because it's too dangerous, then I woudn't doubt that the drug pushers in the streets would gladly say amen to that.

Once again, at least Kratom is much less likely to cause death via overdose.

Once again, I ask you to offer proof of your statement. Back it up with evidence. Mu receptors are responsible for respiratory depression, which is what kills people in overdose. Kratom acts at mu receptors. Why would it be any less likely to kill people than anything else that acts at mu receptors?

TO THE EDITOR:
Kratom (Mitragyna speciosa) is an herbal drug identified by the Food and Drug Administration (FDA) as an opioid for which there is “no evidence of safety or effectiveness for any medical use.”1 The drug is derived from a tropical tree native to Southeast Asia whose leaves have been used traditionally to increase energy among laborers and to treat pain and illness. At higher doses, kratom has opioid-like effects.2 Kratom use has become popular as an alternative medicine for the treatment of pain, mood disorders, and opioid withdrawal.3 Mitragynine is the most abundant of the many alkaloids in kratom and is responsible for its clinical and psychoactive effects. Activity occurs through agonism at mu receptors and antagonism at delta receptors, which may explain the apparently reduced risk of respiratory depression associated with kratom as compared with pure mu agonists, such as heroin and oxycodone.4

It has been asserted that no deaths solely attributable to mitragynine have been documented,2 although the scope of use is unknown, in part because routine drug testing does not detect mitragynine. The FDA issued a warning on February 6, 2018,1 stating that three-dimensional computational modeling of mitragynine reveals a structural similarity to opioids, with binding to mu-opioid receptors. In the warning, the FDA reported 44 deaths associated with kratom use, including 1 that was associated with mitragynine only. These findings have prompted the FDA to issue warning letters to numerous businesses that sell kratom illegally.5

We reviewed Colorado death certificates for any mention of kratom or mitragynine from 1999 through 2017 and identified 15 kratom-related deaths (see the Supplementary Appendix, available with the full text of this letter at NEJM.org). Autopsy reports were reviewed for all 15 deaths, which included 13 men and 2 women, with a median age of 28 years (range, 24 to 53). On the basis of toxicology testing, 11 cases involved multidrug ingestion (two to six drugs), and 8 persons had positive test results for other opioids. Four deaths were reported to involve mitragynine only, and coroners attributed each to mitragynine toxicity.

We further investigated the 4 deaths that appeared to be due to mitragynine only, reviewing police investigation records for all 4 and performing comprehensive toxicology screening with high-performance liquid chromatography with tandem mass spectrometry for the 3 cases for which residual blood was available (Table 1). In our investigation of all 15 kratom-related deaths, we determined that 14 deaths clearly involved multiple drugs. Mitragynine levels varied widely, from 16 to 4800 ng per milliliter. Residual blood was not available for confirmatory testing in the remaining kratom-related death.

It is likely that mitragynine increases the risk of adverse events, especially when ingested with opioids or psychoactive drugs. Careful examination of deaths apparently due to kratom only must include comprehensive toxicology screening. Further study is needed to assess the safety and potential effectiveness of kratom as an herbal drug.

Abstract
A 17-year-old white man who showed no obvious signs of trauma was found unresponsive in bed and was pronounced dead at the scene. The decedent had a documented history of heroin abuse and chronic back pain and reportedly self-medicated with Kratom (mitragynine). The autopsy was remarkable only for pulmonary congestion and edema and a distended bladder, both of which are consistent with, though not diagnostic of, opiate use. A laboratory work-up revealed therapeutic levels of over-the-counter cold medications and benzodiazepines. However, of interest was a level of mitragynine at 0.60 mg/L. Given the facts of the case, the Medical Examiner certified the cause of death as "possible Kratom toxicity" and the manner of death was classified as "accident."

Abstract
Kratom (Mitragyna speciosa) is a plant consumed throughout the world for its stimulant effects and as an opioid substitute (1). It is typically brewed into a tea, chewed, smoked, or ingested in capsules (2). It is also known as Thang, Kakuam, Thom, Ketum, and Biak (3). The Drug Enforcement Administration includes kratom on its Drugs of Concern list (substances that are not currently regulated by the Controlled Substances Act, but that pose risks to persons who abuse them), and the National Institute of Drug Abuse has identified kratom as an emerging drug of abuse (3,4). Published case reports have associated kratom exposure with psychosis, seizures, and deaths (5,6). Because deaths have been attributed to kratom in the United States (7), some jurisdictions have passed or are considering legislation to make kratom use a felony (8). CDC characterized kratom exposures that were reported to poison centers and uploaded to the National Poison Data System (NPDS) during January 2010-December 2015. The NPDS is a national database of information logged by the country's regional poison centers serving all 50 United States, the District of Columbia, and Puerto Rico and is maintained by the American Association of Poison Control Centers. NPDS case records are the result of call reports made by the public and health care providers.

Has no Rx for his orange obsession.

So, @StillwaterTownie , I ask again, kratom acts at opioid mu receptors. Mu receptors are responsible for causing respiratory depression which is what causes death in opioid overdose. Why would kratom be any safer than anything else that acts at opioid mu receptors. Please back up what you say with data, evidence, not just empty words.

Special Teams Coach

Once again, I ask you to offer proof of your statement. Back it up with evidence. Mu receptors are responsible for respiratory depression, which is what kills people in overdose. Kratom acts at mu receptors. Why would it be any less likely to kill people than anything else that acts at mu receptors?

Pretty easy to find on pub med:
"Despite increasing reports and studies on Kratom, to our knowledge, respiratory depression or significant opioid toxic syndrome have not been reported as the toxicity from Kratom.7,14,35 Even if Kratom is mainly available as a drug of abuse, it may yet provide insight into the possibility for its medicinal development as a new and more effective opioid substitute or pain killer in the future, with fewer lethal side effects."

There are still many studies to be done, so this initial finding may not be the case. That being said, your post about the lethality mentions that no overdoase deaths have been the result of kratom alone. That makes sense in light of the above study.

Territorial Marshal

I think when it come to milligram to milligram it would take significantly larger amounts of Kratom to get the same effects of a single does oxycodone. From what I've read, users trying to ween themselves off prescription opiates report using a table spoon of Kratom 2-3 times a day and report that it satisfies the withdraw symptoms and it replaces the "high" they were seeking with a mild mellow feeling.

Federal Marshal

So, @StillwaterTownie , I ask again, kratom acts at opioid mu receptors. Mu receptors are responsible for causing respiratory depression which is what causes death in opioid overdose. Why would kratom be any safer than anything else that acts at opioid mu receptors. Please back up what you say with data, evidence, not just empty words.

Deaths caused by opioid overdose have been rising every year until it's getting close to 50,000. And it seems you want to worry about the number of deaths associated with Kratom, which is only 44. For all you know, more people than 44 die every year from being dumb enough to down too much Everclear. Shall Everclear be banned?

Federal Marshal

I think when it come to milligram to milligram it would take significantly larger amounts of Kratom to get the same effects of a single does oxycodone. From what I've read, users trying to ween themselves off prescription opiates report using a table spoon of Kratom 2-3 times a day and report that it satisfies the withdraw symptoms and it replaces the "high" they were seeking with a mild mellow feeling.

Has no Rx for his orange obsession.

I think when it come to milligram to milligram it would take significantly larger amounts of Kratom to get the same effects of a single does oxycodone. From what I've read, users trying to ween themselves off prescription opiates report using a table spoon of Kratom 2-3 times a day and report that it satisfies the withdraw symptoms and it replaces the "high" they were seeking with a mild mellow feeling.

Which is clinically irrelevant. We convert equi-analgesic dosages between opiates all the time. Morphine is mg per mg more potent than codeine, but if you give 6.7 mg of codeine you have the equivalent of 1 mg of morphine. Fentanyl 1 mcg is equal to morphine 2.4 mg. Take enough of the kratom, equipotent doses, and you will cause respiratory depression at mu receptors just like you would with any other opioid.

Has no Rx for his orange obsession.

Deaths caused by opioid overdose have been rising every year until it's getting close to 50,000. And it seems you want to worry about the number of deaths associated with Kratom, which is only 44. For all you know, more people than 44 die every year from being dumb enough to down too much Everclear. Shall Everclear be banned?

So I guess to you almost nobody has ever heard of kratom. Therefore, that is the main reason why there are so very few overdose deaths compared to opioids. In other words, a typical household is far more likely to have opioids in it than kratom.

In Oklahoma, Everclear is as available to adults as anything else in a liquor store.